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目的:评价国产蘑菇伞经导管介入治疗成人动脉导管未闭(PDA)的临床疗效。方法:选择我科156(男54,女102)例成人PDA实施经导管介入治疗的患者,年龄18~65(32±13)岁;体质量43.8~68.5(51±8)kg;行右心导管检查测定肺动脉压力、主动脉压力,行主动脉弓降部造影,确定PDA位置、形状及大小,PDA最窄处内径1.5~18.2(5±5)mm。以国产蘑菇伞堵闭器行介入治疗,根据封堵实验决定能否行永久封堵。术后24 h、1、3、6和12个月行彩色多普勒超声心动图检查随访。结果:4例封堵后30 min肺动脉收缩压无下降,反而有轻度上升,考虑为阻力性重度肺动脉高压,撤出封堵器。余152例成功地植入封堵器,术后30 min肺动脉压收缩压由术前(48±23)mmHg降为(36±12)mmHg(P<0.05),肺动脉平均压降由术前(40±14)mmHg降为(27±11)mmHg(P<0.05),主动脉压由术前(102±13)mmHg变化至(107±14)mmHg(P>0.05)。术后30 min主动脉弓降部造影显示,119例(78.3%)封堵完全,33例(21.7%)可见极少量残余分流,术后24 h心脏彩超复查147例(96.7%)封堵完全,5例(3.3%)有少量残余分流,术后1个月彩超复查皆无残余分流;无再通和堵闭器移位等并发症发生。结论:在不可逆性阻力性重度肺动脉高压发生前应用国产蘑菇伞经导管封堵治疗成人PDA是一种安全、简便、有效、创伤小、恢复快的方法。
OBJECTIVE: To evaluate the clinical efficacy of homemade mushroom umbrella in the treatment of adult patent ductus arteriosus (PDA) by catheterization. Methods: A total of 156 adult (54 male and female 102) PDA patients in our department were enrolled in this study. The age ranged from 18 to 65 years old (32 ± 13) years old. The body weight ranged from 43.8 to 68.5 (51 ± 8) kg. Catheterization was performed to measure pulmonary artery pressure, aortic pressure, angioplasty of the aortic arch, and to determine the location, shape and size of the PDA. The narrowest internal diameter of the PDA was 1.5 to 18.2 (5 ± 5) mm. To domestic Mushroom umbrella blocker interventional treatment, according to the blocking experiment decided whether the line of permanent sealing. Color Doppler echocardiography was followed up at 24 h, 1, 3, 6 and 12 months after operation. Results: In 4 cases, pulmonary artery systolic pressure did not decrease at 30 min after occlusion. On the contrary, the pulmonary artery systolic pressure increased slightly. Considered as resistance severe pulmonary hypertension, the occluder was withdrawn. Fifty-two patients were successfully implanted into the occluder. The systolic pressure of pulmonary arterial pressure decreased from (48 ± 23) mmHg to (36 ± 12) mmHg at 30 min after operation (P <0.05) 40 ± 14 mmHg to 27 ± 11 mmHg, and aortic pressure was changed from 102 ± 13 mmHg to 107 ± 14 mmHg before surgery (P> 0.05). Aortic arch imaging at 30 min showed complete occlusion of 119 cases (78.3%), minimal residual shunt in 33 cases (21.7%), complete occlusion of 147 cases (96.7%) at 24 h after operation, A small amount of residual shunt occurred in 3 cases (3.3%). There was no residual shunt after color Doppler ultrasound examination in 1 month after operation. No complications such as recanalization and occluder displacement occurred. Conclusion: It is a safe, simple, effective, less traumatic and faster recovery method to treat adult PDA with domestic Mushroom umbrella before catheterization of irreversible resistance severe pulmonary hypertension.